Are 27 Million Annual Dental Antibiotic Prescriptions Truly Necessary?

By Genni Burkhart, Editor

Antibiotics have long been a routine part of dental care. A tooth extraction, an implant, or a root canal is often followed by a prescription. For decades, dental schools taught clinicians to prescribe them prophylactically, a practice grounded in patient safety and a desire to prevent complications. However, the science on antibiotics has shifted considerably, while prescribing hasn't.

This gap is drawing increased scrutiny. For example, a February 2026 investigative series from the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota examined antibiotic prescribing in dentistry using national data from the IQVIA Institute for Human Data Science™. Instead of condemning the profession, the findings call for reevaluating a well-intentioned habit and recognizing why updating it matters for patients everywhere.

The Numbers Tell an Interesting Story

Looking at the data, IQVIA figures provided exclusively to CIDRAP show dentists wrote 27.3 million antibiotic prescriptions in 2025. While that number alone isn't new, the direction is worth noting. Dental antibiotic prescriptions rose 6% from 2020 to 2025, even as prescribing elsewhere in medicine declined.

However, there are some encouraging signs within that data. Prescriptions for clindamycin, the second-most prescribed dental antibiotic, dropped 35% over the same period, which suggests guidelines are having some effect. Yet, the profession's total prescribing volume is still climbing. Amoxicillin prescriptions rose nearly 13%, and azithromycin, a safer alternative to clindamycin for patients with reported penicillin allergies, climbed 83%. That shift in drug selection reflects some progress, although the overall volume tells a different story.

With that context, let's look at additional data.

A 2019 study published in JAMA Network Open by Suda et al., drawing on national insurance claims data from 2011 to 2015, found that 80% of preventive dental antibiotic prescriptions were inconsistent with clinical guidelines. Most were written for patients who didn't actually meet the criteria for prophylaxis under current evidence. That data is now several years old, but the prescribing trends suggest the problem hasn't yet been resolved.

Why Clindamycin Deserves Particular Attention

Even with its 35% decline, clindamycin remains the second-most prescribed antibiotic in dentistry, and it carries risks that most patients don't know about. The drug has carried a Food and Drug Administration (FDA) black box warning for more than four decades due to its association with Clostridioides difficile, more commonly known as C. diff.

C. diff sickens roughly half a million Americans each year and kills nearly 30,000. More than half of the people who develop community-associated C. diff infections have taken antibiotics recently. In fact, according to CIDRAP, 15% of those cases are linked to a dental procedure. As such, Clindamycin is particularly problematic, with research showing that even a single dose carries a significant risk of C. diff.

The American Heart Association (AHA) updated its guidelines in 2021, specifically removing clindamycin as a preventive option. The American Dental Association (ADA) also issued updated guidance discouraging its use unless no other safe alternative exists. Yet dentists still wrote more than 2.3 million clindamycin prescriptions in 2025. Behavior change in medicine is never fast or simple. The evidence has clearly shifted, but prescribing practices haven't yet caught up.

Structural Challenges

One reason antibiotic stewardship has taken hold faster in hospitals than in dental practices is structural. Hospitals are federally required to implement stewardship programs. Dental practices, which largely operate as private outpatient offices, aren't subject to the same requirements. As such, they've historically been excluded from broader stewardship efforts.

There's also an overlooked data gap. A dentist can check a prescription drug monitoring program (PDMP) to see whether a patient has been prescribed opioids. But there's currently no equivalent system for antibiotics. And because physicians and dentists typically use incompatible electronic health record systems, a dentist typically has no way to know if a patient has a prior C. diff history unless the patient mentions it, and most don't think to do so.

Clinically, that missing context matters.

The Penicillin Allergy Factor

One of the most actionable takeaways from CIDRAP's reporting concerns penicillin allergies. Roughly 10% of patients report being allergic to penicillin. The actual rate, according to the Centers for Disease Control and Prevention (CDC), is below 1%. In most cases, what patients remember as an allergic reaction is actually a side effect, such as nausea or a mild rash, and 8 out of 10 people with true penicillin allergies lose that sensitivity within 10 years.

This matters for a key reason.

When a patient lists a penicillin allergy, dentists often default to second-line antibiotics such as clindamycin, which are less effective and carry a higher risk. Referring patients with documented penicillin allergies to an allergist for definitive testing is an underused but genuinely useful clinical strategy. If the allergy is ruled out, the patient's record can be updated, and the practice has broader, safer options going forward.

Applications in Practice

None of this is to say the dental profession is ignoring this issue. The ADA published prescribing guidelines in 2019, encouraging a shift from prescribing 'just in case' to prescribing only when clinically warranted. Furthermore, antibiotic stewardship is gaining traction in dental education. In fact, The Incisor has covered this topic extensively, and DOCS Education offers several courses on best practices for prescribing antibiotics.

Reassuringly, the data does show some improvement in drug selection, even if overall volume has not yet declined. Dental professionals can take concrete steps to improve antibiotic stewardship now:

• Review prescribing habits against current ADA guidelines, particularly for extractions and implants. These two procedures account for roughly half of all dental antibiotic prescriptions and currently lack specific prescribing guidelines.
• Approach penicillin allergy histories with more clinical scrutiny. Most reported allergies aren't true allergies. Verifying them enables safer prescribing.
• Recognize that C. diff is a downstream consequence of dental prescribing that most practices never see. Those patients end up in emergency rooms, not the dental chair.

Antimicrobial resistance is a shared problem built one prescription at a time. Dentistry writes a significant share of those prescriptions, and that means it also holds a significant share of the solution.

References

1. Szabo, L. (2026, February 24). Dentists still write millions of prescriptions a year for an antibiotic with life-threatening risks. CIDRAP News. https://www.cidrap.umn.edu/antimicrobial-stewardship/dentists-still-wri…

2. Szabo, L. (2026, February 25). Curbing overuse of dental antibiotics proves daunting. CIDRAP News. https://www.cidrap.umn.edu/antimicrobial-stewardship/curbing-overuse-de…

3. Szabo, L. (2026, February 26). How to avoid inappropriate dental antibiotics. CIDRAP News. https://www.cidrap.umn.edu/antimicrobial-stewardship/how-avoid-inapprop…

4. Suda, K. J., Calip, G. S., Zhou, J., Rowan, S., Gross, A. E., Hershow, R. C., Perez, R. I., McGregor, J. C., & Evans, C. T. (2019). Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015. JAMA Network Open, 2(5), e193909. https://doi.org/10.1001/jamanetworkopen.2019.3909

Author: With over 16 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.